How is irritant contact dermatitis managed?

Management of Irritant Contact Dermatitis

The cornerstone of managing irritant contact dermatitis is complete identification and avoidance of the offending irritant, combined with skin barrier restoration through emollients and judicious use of topical corticosteroids for active inflammation. 1, 2

Immediate Action: Identify and Eliminate Irritants

The most critical step is removing exposure to irritants, which commonly include:

• Soaps and detergents (most frequent culprits) 1
• Water itself (often overlooked as an irritant) 1
• Occupational exposures: oils, coolants, alkalis, acids, solvents 1

A workplace visit should be strongly considered for occupational cases, as it helps identify hidden irritants, assess contamination sources, and evaluate safety procedures—this is essential for effective treatment and prevention. 1

Skin Protection Strategy

Hand Protection (Most Common Site)

For household tasks: Use rubber or polyvinyl chloride gloves with cotton liners, but remove them regularly as sweating and occlusion can impair stratum corneum barrier function and worsen dermatitis. 1

For occupational settings: The glove type must match the specific chemical exposure. 1

• Check Material Safety Data Sheets (MSDS) for appropriate glove selection and permeation times 1
• Critical pitfall: "Impervious" gloves have finite permeation times—for example, latex gloves are penetrated by methyl methacrylate in just 1 minute, while nitrile provides only 5 minutes of protection 1

Barrier Creams: Limited Value

Barrier creams alone are of questionable value and should not be overpromoted, as they may create false security and encourage complacency with proper protective measures. 1

However, after-work creams and soap substitutes have proven benefit in reducing incidence and prevalence of irritant contact dermatitis and should be readily available in workplaces. 1

Active Treatment Protocol

First-Line: Emollients and Moisturizers

• Apply moisturizers immediately after washing to repair the skin barrier 2, 3
• Use tube packaging rather than jars to prevent contamination 2, 3
• Select products with humectants to help retain moisture 2
• Consider "soak and smear" technique for intensive treatment: dampen skin with water and immediately apply moisturizer to lock in moisture 2, 3

Topical Corticosteroids for Active Inflammation

For body/hands: Apply mid- to high-potency topical corticosteroid (triamcinolone 0.1% or clobetasol 0.05%) twice daily for acute flares. 3, 4

For facial lesions: Use only low-potency steroids (hydrocortisone 1%) to minimize risk of skin atrophy and steroid-induced damage. 2, 5, 3

For genital/vulvar areas: Apply low to mid-potency steroids (hydrocortisone 1% or triamcinolone 0.1%) twice daily for 1-2 weeks maximum, followed by gradual taper to prevent rebound dermatitis. 5

• Ointment formulations are preferred over creams (fewer preservatives and irritants) 5
• Avoid high-potency steroids due to increased absorption and atrophy risk 5

Duration and monitoring:

• If no improvement after 7-10 days of conservative measures, escalate to stronger topical steroids 2
• Total steroid treatment should generally not exceed 4 weeks 5
• Monitor for skin atrophy, telangiectasia, and perioral dermatitis 3

Second-Line Treatments for Refractory Cases

For steroid-resistant chronic hand dermatitis, consider:

• Topical tacrolimus (steroid-sparing agent, particularly useful for facial/genital areas) 1, 5, 3
• Psoralen plus UVA (PUVA) 1
• Systemic immunosuppressants: azathioprine, ciclosporin 1

These second-line treatments are supported by prospective clinical trials. 1

Critical Pitfalls to Avoid

• Failing to identify and completely remove the causative irritant prevents healing regardless of treatment 2, 3
• Prolonged topical steroid use damages the skin barrier and causes atrophy, telangiectasia, and perioral dermatitis 3
• Using very hot water for washing exacerbates irritant contact dermatitis 3
• Over-reliance on barrier creams creates false security 1
• Rapid discontinuation of systemic steroids (if used) causes rebound dermatitis—taper over 2-3 weeks 4

Prognosis and Follow-Up

The long-term prognosis for occupational irritant contact dermatitis is often poor: Only 25% of patients completely heal over 10 years, with 50% having intermittent symptoms and 25% having permanent symptoms. 1

Changing occupation does not guarantee improvement—in 40% of cases who changed jobs, prognosis was not improved. 1

Re-evaluate if symptoms persist beyond 7 days despite treatment, and consider dermatology referral for recalcitrant cases or if allergic contact dermatitis is suspected. 2

For milder cases with easily avoidable irritants, prognosis is good if complete avoidance is achieved. 1